National Parivar Mediclaim Plus Policy

The National Parivar Mediclaim Plus policy is a comprehensive healthinsurance solution designed specifically for families across India. It combines extensive hospitalisation coverage with optional addons such as outpatient benefits, critical illness cover, and maternity benefits. Below is an indepth look at the policys key features, eligibility, benefits, claim process, and tips to maximise value.

1. Who Can Buy This Policy?

• Policyholder (Head of Family): Indian resident aged 1865 years at the time of purchase.
• Family Members Covered: Spouse, biological children (including stepchildren), legally adopted children, and parents (biological or adoptive) of the policyholder.
• All members must be listed at the time of purchase; additional members can be added during the policy term subject to a waiting period.

2. Core Coverage (Hospitalisation)

The core of the Mediclaim Plus plan is its hospitalisation benefit, which includes:

• Cashless treatment at any network hospital across India.
• Room rent (up to the sum insured), ICU charges, surgeons fees, anesthesiologist fees, and postoperative care.
• Prehospitalisation expenses up to 30 days before admission.
• Posthospitalisation expenses up to 60 days after discharge.
• Coverage for daycare procedures (no overnight stay required).

3. Optional AddOn Covers

Buyers can enhance the base policy with the following riders (each carries an extra premium):

4. Sum Insured Options

Policyholders can choose from a range of sum insured (SI) options:

• 2 lakh, 3 lakh, 5 lakh, 7 lakh, and 10 lakh
• Higher SI (up to 15 lakh) is available for senior citizens (5565 years) with additional underwriting.

All insured members share the total SI on a family floater basis. The sum insured is exhausted once the total claim amount reaches the chosen limit, irrespective of which member incurred the expense.

5. Premium Calculation Factors

The premium depends on:

• Age of the primary insurer and oldest family member.
• Chosen sum insured.
• Geographical zone (metro, urban, rural).
• Selected riders and their sum insured.
• Smoking status (additional load for smokers).

6. Waiting Periods

7. Claim Process Step by Step

1. Cashless Claim: Present your health card, identity proof, and preauthorization form at a network hospital. The insurer settles the bill directly with the hospital.
2. Reimbursement Claim: If treated at a nonnetwork hospital, obtain all original bills, discharge summary, and medical reports. Submit the claim form along with documents through the insurers portal or via email.
3. Claim Acknowledgement: Within 48 hours of receipt, the insurer issues an acknowledgment number.
4. Assessment: A medical officer may request additional information or a physical examination.
5. Settlement: Once approved, the amount is transferred to the policyholders bank account within 15 days (cashless: immediate).

8. Policy Renewal & Continuity

The policy is renewable annually without additional medical underwriting, provided premiums are paid on time. For senior citizens, the insurer may request a health declaration after the 5th renewal year.

9. Key Benefits Summary

• Family floater coverage one sum insured for the entire family.
• Cashless access to a wide network of hospitals.
• Flexibility to add riders tailored to specific needs.
• No cap on room rent for private rooms (subject to SI limit).
• Free coverage for COVID19 treatment (as per latest government guidelines).
• Online premium payment, policy issuance, and claim tracking.

10. Frequently Asked Questions

Q1: Can I add a new child after the policy is issued?

Yes. A newborn can be added within 30 days of birth without a waiting period for core hospitalisation benefits. For riders, the usual waiting periods apply.

Q2: Are alternative therapies (Ayurveda, Homeopathy) covered?

Only if they are part of a recognized hospitals treatment protocol and billed under the cashless network. Standalone alternative therapy costs are not covered.

Q3: What happens if the sum insured is exhausted?

Once the family has exhausted the total sum insured, any further expenses revert to outofpocket payment. Policyholders can consider a higher SI at renewal.

Q4: Is there a grace period for premium payment?

A 15day grace period is provided each policy year. After this, the policy lapses unless a revival fee is paid.

11. How to Buy the Policy

Purchasing can be done through any of the following channels:

• Official website: Fill the online application, upload documents, and pay the premium instantly.
• Mobile app: Download the insurers app for a quick quote and epolicy issuance.
• Insurance agents/brokers: Get personalized assistance, especially for families with complex needs.
• Banks & fintech partners: Many partner banks offer the plan as part of their healthinsurance portfolio.

12. Bottom Line

The National Parivar Mediclaim Plus policy is a versatile, familycentric healthinsurance solution that balances affordable premiums with extensive coverage. Its modular rider structure allows families to customize protection for critical illnesses, maternity, and outpatient care, making it a strong candidate for anyone looking to secure comprehensive health security for all household members.

Before enrolling, compare the sum insured, rider costs, and network hospital list against other market options. Use the free online calculators available on the insurers website to gauge the exact premium for your familys age profile and desired coverage.